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The Journal of Thoracic and... Oct 2013We aimed to analyze the accuracy of video-assisted mediastinoscopic lymphadenectomy (VAMLA) as a tool for preoperative staging and the impact of the technique on... (Comparative Study)
Comparative Study
OBJECTIVES
We aimed to analyze the accuracy of video-assisted mediastinoscopic lymphadenectomy (VAMLA) as a tool for preoperative staging and the impact of the technique on survival in patients with non-small cell lung cancer (NSCLC) undergoing pulmonary resection.
METHODS
Between May 2006 and December 2010, 433 patients underwent pulmonary resection for NSCLC, 89 (21%) had VAMLA before resection and 344 (79%) had standard mediastinoscopy. The patients who had negative VAMLA/mediastinoscopy results underwent anatomic pulmonary resection and systematic lymph node dissection.
RESULTS
The median and mean numbers of resected lymph node stations were 5 and 4.9 in the VAMLA group and 4 and 4.2 in the mediastinoscopy group (P = .9). The mean number of lymph nodes per biopsy specimen using standard mediastinoscopy was 10.1, whereas it was 30.4 using VAMLA (P < .001). VAMLA unveiled N2 or N3 disease in 30 (33.7%) and in 6 (6.7%) of patients, respectively. The negative predictive value, sensitivity, false-negative value, and accuracy of VAMLA were statistically higher in the VAMLA groups compared with those of standard mediastinoscopy. The 5-year survival was 90% for VAMLA patients and 66% for mediastinoscopy patients (P = .01). By multivariable analysis, VAMLA was associated with better survival (odds ratio, 1.34; 95% confidence interval, 1.1-3.2; P = .02).
CONCLUSIONS
VAMLA was associated with improved survival in NSCLC patients who had resectional surgery.
Topics: Adult; Aged; Aged, 80 and over; Biopsy; Carcinoma, Non-Small-Cell Lung; False Negative Reactions; False Positive Reactions; Female; Humans; Kaplan-Meier Estimate; Lung Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Male; Mediastinoscopy; Middle Aged; Multivariate Analysis; Neoplasm Staging; Odds Ratio; Predictive Value of Tests; Propensity Score; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Video-Assisted Surgery; Young Adult
PubMed: 23778084
DOI: 10.1016/j.jtcvs.2013.04.036 -
The American Journal of Case Reports 2013Female, 30 FINAL DIAGNOSIS: Nocardiosis Symptoms: Cardiac tamponade • cough • dyspnea • hoarseness • mediastinal mass • pericardial effusion • short of breath
PATIENT
Female, 30 FINAL DIAGNOSIS: Nocardiosis Symptoms: Cardiac tamponade • cough • dyspnea • hoarseness • mediastinal mass • pericardial effusion • short of breath
MEDICATION
- Clinical Procedure: - Specialty: Transplantology.
OBJECTIVE
Rare disease.
BACKGROUND
Nocardia infections can complicate solid organ transplantation. The usual clinical presentations include pulmonary infiltrates with or without cavitation and subcutaneous and brain abscesses. We report an unusual case of nocardia infection in a kidney transplant recipient that presented as mediastinal mass and was associated with pericardial tamponade.
CASE REPORT
A 30 year old African American renal transplant recipient presented with cough, hoarseness and shortness of breath nine months after kidney transplantation. She received basiliximab perioperatively and her maintenance immunosuppression included tacrolimus, mycophenolate mofetil and prednisone. Computed tomography (CT) showed a large mediastinal mass with a large pericardial effusion. An echocardiogram revealed collapse of the right ventricle consistent with tamponade. We performed emergent pericardiocentesis to treat the tamponade. A mediastinoscopic biopsy of the mediastinal mass was done to establish a diagnosis. The mediastinal biopsy confirmed the growth of Nocardia. After 2 weeks of imipenem and 6 weeks of linezolid, there was marked radiographic improvement in the size of the mediastinal mass.
CONCLUSIONS
We report a rare case of a large mediastinal mass associated with pericardial tamponade from nocardia infection in a renal transplant recipient. An invasive approach may be necessary to obtain tissue diagnosis to direct treatment in these cases. Prompt and appropriate medical therapy leads to marked radiographic improvement.
PubMed: 23940824
DOI: 10.12659/AJCR.889383 -
International Surgery Apr 2015The use of mediastinal surgery for minimally invasive esophagectomy (MIE) has been proposed; however, this method is not performed as radical surgery because it has been...
The use of mediastinal surgery for minimally invasive esophagectomy (MIE) has been proposed; however, this method is not performed as radical surgery because it has been thought to be impossible to perform complete upper mediastinal dissection, including the left tracheobronchial lymph nodes (106tbL). We herein describe a new method for performing complete dissection of the upper mediastinum. We developed a method for performing complete mediastinoscopic esophagectomy as radical surgery via the bilateral transcervical and transhiatal approach in 6 Thiel-embalmed human cadavers. The lower and middle mediastinal lymph nodes are dissected via the transhiatal approach. The dorsal side of the left recurrent nerve is dissected up to the aortic arch and left recurrent nerve lymph nodes (106recL) are dissected under pneumomediastinum. Next, the right recurrent nerve lymph nodes (106recR) are dissected. The cartilage of the left main bronchus is dissected and pushed downward, thereby obtaining a good view between the aortic arch and left main bronchus via the transhiatal approach. The 106tbL lymph nodes are dissected until the aortic arch is reached. Simultaneously, the lymph nodes are dissected via a right cervical incision. This method is termed the "cross-over technique." We herein demonstrated that the upper mediastinal lymph nodes, including the 106tbL nodes, can be dissected using the bilateral transcervical and transhiatal approach under pneumomediastinum and named this method "mediastinoscopic esophagectomy with lymph node dissection" (MELD). MELD is therefore considered to be a useful modality based on our experience with Thiel-embalmed human cadavers.
Topics: Cadaver; Embalming; Esophagectomy; Humans; Lymph Node Excision; Mediastinal Emphysema; Mediastinoscopy; Mediastinum
PubMed: 25875536
DOI: 10.9738/INTSURG-D-14.00305.1 -
The Thoracic and Cardiovascular Surgeon... Dec 2016Dilational tracheotomy is a minimally invasive method that can be performed at the bedside on patients requiring long-term mechanical ventilation. In our 70-year-old...
Dilational tracheotomy is a minimally invasive method that can be performed at the bedside on patients requiring long-term mechanical ventilation. In our 70-year-old male patient, percutaneous dilational tracheotomy (Ciaglia Blue Rhino, Cook Medical Inc., Bloomington, Indiana, United States) was performed because of bilateral pneumonia with sepsis. There were no initial problems. Nine days later, while the patient was being repositioned, the tracheal cannula became dislocated. Despite extending the cervical incision it was not possible to recannulate. The tracheal hole could not be felt with certainty by palpating through the incision. After several unsuccessful attempts, the patient was intubated orally. The only way to achieve sufficient ventilation was to hold the tracheostoma closed. Bronchoscopy showed that the entry point of the tracheal cannula was ventral and ∼1.5 cm above the main carina. The tube was then advanced into the right main bronchus and the patient was thus ventilated unilaterally. On exposure of the trachea, a grade 3 goiter was revealed. Total neck length was short. Only after the video mediastinoscope had been inserted was it possible to show the tracheal defect below the brachiocephalic trunk. After blunt mobilization of both main bronchi, it was possible to close the tracheal defect with simple interrupted sutures. Conventional tracheotomy was then performed at the level of the second tracheal ring. As a result, mechanical ventilation was once again possible without difficulty and thoracotomy was not necessary.
PubMed: 28018810
DOI: 10.1055/s-0035-1566263 -
JA Clinical Reports Feb 2024Mediastinoscopic surgery for esophageal cancer facilitates early postoperative recovery. However, it can occasionally cause serious complications. Here, we present the...
BACKGROUND
Mediastinoscopic surgery for esophageal cancer facilitates early postoperative recovery. However, it can occasionally cause serious complications. Here, we present the case of a patient with a tracheal injury diagnosed by a sudden increase in end-tidal carbon dioxide (EtCO) during mediastinoscopic subtotal esophagectomy.
CASE PRESENTATION
A 52-year-old man diagnosed with esophageal cancer was scheduled to undergo mediastinoscopic subtotal esophagectomy. During the mediastinoscopic procedure, the EtCO level suddenly increased above 200 mmHg, and the blood pressure dropped below 80 mmHg. We immediately asked the operator to stop insufflation and found a tracheal injury on the right side of the trachea near the carina by bronchoscopy. The endotracheal tube was replaced with a double-lumen tube, and the trachea was repaired via right thoracotomy. There were no further intraoperative complications. After surgery, the patient was extubated and admitted to the intensive care unit.
CONCLUSIONS
Monitoring EtCO levels and close communication with the operator is important for safely managing sudden tracheal injury during mediastinoscopic esophagectomy.
PubMed: 38349592
DOI: 10.1186/s40981-024-00695-3 -
International Journal of Surgery Case... 2016Cervical mediastinoscopy can provide a minimally invasive access to the paratracheobronchial mediastinum within its reachable range, but its operability is substantially...
INTRODUCTION
Cervical mediastinoscopy can provide a minimally invasive access to the paratracheobronchial mediastinum within its reachable range, but its operability is substantially limited because of its small operative field, poor visualisation, and one-handed operation.
PRESENTATION OF CASES
Patient 1, a 56-year-old woman, presented with a 22×17mm, non-symptomatic, (18)F-fluorodeoxy glucose (FDG)-avid, solid schwannoma originating from the vagus nerve trunk in the right upper paratracheal space. Patient 2, a 55-year-old man, presented with a 55×41mm cystic mass in the left upper paratracheal space that extensively compressed and dislocated the trachea toward the right, which caused dyspnoea and cervicothoracic pain. The masses in both cases were completely resected using a Linder-Dahan spreadable-blade video mediastinoscope.
DISCUSSION
The addition of the video system and spreadable blades to the conventional scope combined with a scope-holding device has enabled effective bi-manual preparation and more precise and safer mediastinoscopic procedures than those performed using the conventional one-handed mediastinoscope. Owing to the improved operability, more complex or extended procedures could be performed in wider and more stable operative spaces with better visualisation, although the system has the same minimal invasiveness as that of the conventional mediastinoscope.
CONCLUSION
We describe two patients with mediastinal lesions that were effectively resected by using this sophisticated video mediastinoscope system.
PubMed: 27179334
DOI: 10.1016/j.ijscr.2016.05.002 -
Cancer Research and Treatment Apr 2005In this study, we examined whether additional, delayed regional FDG PET scans could increase the accuracy of the lymph node staging of NSCLC patients.
PURPOSE
In this study, we examined whether additional, delayed regional FDG PET scans could increase the accuracy of the lymph node staging of NSCLC patients.
MATERIALS AND METHODS
Among 87 patients who underwent open thoracotomy or mediastinoscopic biopsy under the suspicion of NSCLC, 35 (32 NSCLC and 3 infectious diseases) who had visible lymph nodes on both preoperative whole body scan and regional FDG PET scan were included. The following 3 calculations were made for each biopsy-proven, visible lymph node: maximum SUV of whole body scan (WB SUV), maximum SUV of delayed chest regional scan (Reg SUV), and the percent change of SUV between WB and regional scans (% SUV Change). ROC curve analyses were performed for WB SUVs, Reg SUVs and % SUV Changes.
RESULTS
Seventy lymph nodes (29 benign, 41 malignant) were visible on both preoperative whole body scan and regional scan. The means of WB SUVs, Reg SUVs and % SUV Changes of the 41 malignant nodes, 3.71+/-1.08, 5.18+/-1.60, and 42.59+/-33.41%, respectively, were all significantly higher than those of the 29 benign nodes, 2.45+/-0.73, 3.00+/-0.89, and 22.71+/-20.17%, respectively. ROC curve analysis gave sensitivity and specificity values of 80.5% and 82.8% at a cutoff of 2.89 (AUC 0.839) for WB SUVs, 87.8% and 82.8% at a cutoff of 3.61 (AUC 0.891) for Reg SUVs, and 87.8% and 41.4% at a cutoff of 12.3% (AUC 0.671) for % SUV Changes.
CONCLUSION
Additional, delayed regional FDG PET scans may improve the accuracy of lymph node staging of whole body FDG PET scan by providing additional criteria of Reg SUV and % SUV Change.
PubMed: 19956490
DOI: 10.4143/crt.2005.37.2.114 -
Journal of Medical Case Reports Nov 2009We performed video-thoracoscopy with a video-mediastinoscope to conduct a mediastinal lymph node biopsy. Here, we discuss the various advantages of the method.
INTRODUCTION
We performed video-thoracoscopy with a video-mediastinoscope to conduct a mediastinal lymph node biopsy. Here, we discuss the various advantages of the method.
CASE PRESENTATION
A 56-year-old Turkish Caucasian man had been complaining of dyspnea on exertion, hacking cough, fever and continuous sweating for one and a half months. Thoracic computed tomography revealed enlarged paratracheal and aorticopulmonary lymph nodes, the largest of which was 1 cm in diameter and reticulo-micronodular interstitial infiltration extending symmetrically to the pleural surfaces in both pulmonary perihilar areas. Computed tomography supported positron emission tomography showed increased fluorodeoxyglucose retention in lymph nodes in both hilar areas (10R and 10L) (maximum standardized uptake values 5.6 and 5.7), and in the right lower paratracheal (4R) (maximum standardized uptake value 4.1) and right para-esophageal (8) (maximum standardized uptake value 8.9) lymph nodes. Pathological examination of the right lymph node number 8 biopsy using the video-mediastinoscope revealed the presence of granulomatous inflammation. No problems were observed during the postoperative period.
CONCLUSION
The use of the video-mediastinoscope for inferior lymph node biopsy in thoracoscopy is an easy, safe and practical method, especially in patients with pleural adhesions.
PubMed: 19946513
DOI: 10.1186/1752-1947-3-96 -
The Journal of Thoracic and... May 2006We sought to examine the distribution and prognostic implications of nodal metastasis in patients undergoing extrapleural pneumonectomy for malignant mesothelioma in a...
OBJECTIVE
We sought to examine the distribution and prognostic implications of nodal metastasis in patients undergoing extrapleural pneumonectomy for malignant mesothelioma in a specialist center.
METHODS
We have examined the lymphadenectomy specimens from 92 consecutive cases of malignant mesothelioma undergoing extrapleural pneumonectomy from September 1999 through February 2005 inclusive. Nodal stations (Naruke) were assigned to all nodes, and patients were staged according to the current International Union Against Cancer system. The status and number of nodes in each station were recorded, and results were correlated with the results of preoperative mediastinoscopic findings (n = 30) and survival.
RESULTS
The nodal distribution was 48 N0, 9 N1, and 35 N2. Single and multistation nodal involvement was present in 20 and 24 cases, respectively. Among the patients undergoing mediastinoscopy, N2 disease after extrapleural pneumonectomy occurred in 10 (33%). Skip N2 metastasis was present in 10 (42%) cases. Positive N2 nodes inaccessible by mediastinoscopy were present in 17 (49%) cases. N2 metastasis was associated with reduced survival (P = .02), but there was no difference between N1 and N2 cases (P = .4). The number of positive nodes correlated with survival (P = .001), although the number of involved stations and their anatomic location did not. There was no difference in survival between skip N2 cases and either other N2 or N1 cases.
CONCLUSIONS
The classical anatomic location is not as important as the scatter of nodal involvement. Every effort should be made to obtain biopsy specimens from as many stations as possible before undertaking extrapleural pneumonectomy for malignant mesothelioma.
Topics: Adult; Aged; Combined Modality Therapy; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Mesothelioma; Middle Aged; Neoplasm Staging; Pleural Neoplasms; Pneumonectomy; Prognosis; Survival Analysis; Thoracic Cavity; Treatment Outcome
PubMed: 16678579
DOI: 10.1016/j.jtcvs.2005.11.044 -
Journal of Cancer Research and... 2013Mediastinal lymphadenopathy in patients with malignancy is a common clinical problem in tuberculosis-endemic countries. The recently developed endobronchial...
Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of intrathoracic lymphadenopathy in patients with extrathoracic malignancy: A study in a tuberculosis-endemic country.
BACKGROUND
Mediastinal lymphadenopathy in patients with malignancy is a common clinical problem in tuberculosis-endemic countries. The recently developed endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) procedure enables direct and real-time aspiration of mediastinal and hilar lymph nodes. The aim of the study was to determine the efficacy of EBUS-TBNA results in the evaluation of mediastinal lymph nodes in patients with extrathoracic malignancy.
MATERIALS AND METHODS
Retrospective analysis was performed in 40 patients with proven (n = 38) or suspected metastasis of unknown origin (n = 2) who underwent EBUS-TBNA between July 2007 and August 2011.
RESULTS
All 40 patients successfully underwent EBUS-TBNA and no complications were observed. EBUS-TBNA diagnosed metastasis from extrathoracic malignancy in 16 (40%) patients, new lung cancer in 2 (5%), reactive lymph node in 9 (22.5%), sarcoidosis in 5 (12.5%), anthracosis in 5 (12.5%) and tuberculosis in 3 (7.5%). The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of EBUS-TBNA based on the number of patients were 90.0%, 100%, 100%, 90.9% and 95.0%, respectively. In 33 patients with available data of fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) scans, the diagnostic sensitivity, specificity, PPV, NPV and accuracy of PET/CT scan based on the number of patients were 94.7%, 35.7%, 66.6%, 83.3%, and 69.6%, respectively. The association between larger lymph node size on EBUS and malignancy of lymph node sample on pathological examination was statistically significant (P = 0.018).
CONCLUSIONS
EBUS-TBNA is a sensitive, specific, minimally invasive and a safe procedure for the diagnosis of mediastinal and hilar metastasis from extrapulmonary malignancy in a tuberculosis-endemic country.
Topics: Adult; Aged; Algorithms; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Mediastinal Neoplasms; Mediastinoscopes; Mediastinum; Middle Aged; Positron-Emission Tomography; Reproducibility of Results; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 24125976
DOI: 10.4103/0973-1482.119323